ArticleThe Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association2024
Rural-urban disparities in health care delivery for children with medical complexity and moderating effects of payer, disability, and community poverty.
Article in The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
What it found
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
13 citing papers in PubMed, 17 citations in OpenAlex.
- Associations of rurality, child opportunity, and distance with use of pediatric asthma specialists.The Journal of allergy and clinical immunology · 2026Article
- Identifying Endocrinology Nurse Practitioners and Physician Associates Using Claims Data.The journal for nurse practitioners : JNP · 2026Article
- Too far to care? A cohort study on travel distance and hospital use in children living with respiratory support.BMJ open respiratory research · 2026Article
- Do Rural-Urban Disparities Translate into Nursing Complexity at Hospital Admission? Evidence from a Single Tertiary-Care Pediatric Hospital in Italy.Children (Basel, Switzerland) · 2026Article
- Socioeconomic Status, Rurality, and Pediatric Critical Care Admission.JAMA network open · 2026Article
- Missingness in the National Cancer Database: A Novel Surrogate for Hepatobiliary Cancer Outcomes.Annals of surgical oncology · 2026Article
- The assessment of continuity of care and care coordination for Children and Youth with Special Health Care Needs (CYSHCN): a cross-sectional descriptive study in Northeastern Italy.Italian journal of pediatrics · 2025Article
- Trends in Hospital Resource Use for Children With Complex Chronic Conditions.JAMA network open · 2025Article
- Rural-Urban Differences in Emergency Department Choice for Children With Medical Complexity, 2012-2017.Pediatric emergency care · 2025Article
- Differences in COVID-19 testing perceptions among caregivers of children with medical complexity by rurality.PloS one · 2025Article
- Service access for youth with neurodevelopmental disabilities transitioning to adulthood: service providers' and decision-makers' perspectives on barriers, facilitators and policy recommendations.Frontiers in public health · 2025Article
- Rural-Urban Disparities in Hospital Services and Outcomes for Children With Medical Complexity.JAMA network open · 2024Article
- Medicaid‑Insured Children with Medical Complexity in a Rural State.Academic pediatricsArticle
Corrections and comments
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Authors and funding
8 authors at 2 institutions in 1 country.
Funding
Abstract
purposeChildren with medical complexity (CMC) may be at increased risk of rural-urban disparities in health care delivery given their multifaceted health care needs, but these disparities are poorly understood. This study evaluated rural-urban disparities in health care delivery to CMC and determined whether Medicaid coverage, co-occurring disability, and community poverty modified the effects of rurality on care delivery.
methodsThis retrospective cohort study of 2012-2017 all-payer claims data from Colorado, Massachusetts, and New Hampshire included CMC <18 years. Health care delivery measures (ambulatory clinic visits, emergency department visits, acute care hospitalizations, total hospital days, and receipt of post-acute care) were compared for rural- versus urban-residing CMC in multivariable regression models, following established methods to evaluate effect modification.
findingsOf 112,475 CMC, 7307 (6.5%) were rural residing and 105,168 (93.5%) were urban residing. A total of 68.9% had Medicaid coverage, 33.9% had a disability, and 39.7% lived in communities with >20% child poverty. In adjusted analyses, rural-residing CMC received significantly fewer ambulatory visits (risk ratio [RR] = 0.95, 95% confidence interval [CI]: 0.94-0.96), more emergency visits (RR = 1.12, 95% CI: 1.08-1.16), and fewer hospitalization days (RR = 0.90, 95% CI = 0.85-0.96). The estimated modification effects of rural residence by Medicaid coverage, disability, and community poverty were each statistically significant. Differences in the odds of having a hospitalization and receiving post-acute care did not persist after incorporating sociodemographic and clinical characteristics and interaction effects.
conclusionsRural- and urban-residing CMC differed in their receipt of health care, and Medicaid coverage, co-occurring disabilities, and community poverty modified several of these effects. These modifying effects should be considered in clinical and policy initiatives to ensure that such initiatives do not widen rural-urban disparities.
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